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Communicable diseases represent a public health problem in developing countries, especially in those affected by disasters, and necessitate an appropriate and coordinated response from national and international partners. The importance of rapid epidemiological assessment for public health planning and resources allocation is critical. This review assesses infectious disease outbreaks during and after disasters caused by natural hazards and describes comprehensive prevention and control measures. The natural hazard event that causes a disaster does not transmit infectious diseases in the immediate aftermath of the disaster, nor do dead bodies. During the impact phase, most of the deaths are associated to blunt trauma, crush-related injuries, burns, and drowning rather than from infectious diseases. Most pathogens cannot not continue to survive in a corpse. The remaining survivors are the ones from which infectious diseases can be transmitted under appropriate conditions created by the natural disasters. Among several diseases, diarrheal diseases, leptospirosis, viral hepatitis, typhoid fever, acute respiratory infections, measles, meningitides, tuberculosis, malaria, dengue fever, and West Nile Virus commonly were described days, weeks, or months after the disaster event in areas where they are endemic. Therefore, diseases can also be imported by healthy carriers among a susceptible population. The objective of the public health intervention is to prevent and control epidemics among the disaster-affected populations. The rapid implementation of control measures should be a public health priority especially in the absence of pre-disaster surveillance data, through the re-establishment and improvement of the delivery of primary health care and restoration of affected health services. Adequate shelter and sanitation, water and food safety, appropriate surveillance, immunization and management approaches, as well health education will be strongly required for the reduction of morbidity and mortality.
The experiences Afghan medical personnel gained from the “Emergency Care for Trauma” course are described in this presentation.
Method
The course was conducted 14–15 April, 2010 in Kabul, Afghanistan. It was evaluated retrospectively for: (1) course curriculum; (2) training instructors; (3) participant characteristics; (4) participant evaluations and course of events; (5) preparation; (6) execution; and (7) results.
Results
The course included 13 hours of theoretical discussion, six hours of skill practice stations, and 19 hours of training. The organization committee was composed of a president, two secretaries, six trainers, and six assistant trainers. There were three language interpreters. A total of 24 medical personnel attended the course. Pre- and post-tests were administered to the participants in order to evaluate the effectiveness of the course. Simultaneous translation was performed during the training sessions. The correct response rates for test questions increased from 34.6% prior to the course, to 80.3% after the course. At the end of course, reviews from the participants were discussed.
Discussion
The participants suggested that the course should be repeated every six months. It was decided that there should be more time for the practical portion of the course. It was determined that the course would be integrated into the Afghan health system.
Conclusion
Post-graduate courses are important components of the modern health care system. In many developed countries, these courses have become compulsory and are conducted regularly. However, standardized and regularly performed courses should be supported in developing countries.
Disasters and incidents with hundreds, thousands, or tens of thousands of casualties are not generally addressed in hospital disaster plans. Nevertheless, they may occur, and recent disasters around the globe suggest that it would be prudent for hospitals to improve their preparedness for a mass casualty incident. Disaster, large or small, natural or man-made can strike in many ways and can put the hospital services in danger. Hospitals, because of their emergency services and 24 hour a day operation, will be seen by the public as a vital resource for diagnosis, treatment, and follow up for both physical and psychological care.
Objectives
Develop a hospital-based disaster and emergency preparedness plan. Consider how a disaster may pose various challenges to hospital disaster response. Formulate a disaster plan for different medical facility response. Assess the need for further changes in existing plans.
Methods
The author uses literature review and his own experience to develop step-by-step logistic approach to hospital disaster planning. The author presents a model for hospital disaster preparedness that produces a living document that contains guidelines for review, testing, education, training and update. The model provides the method to develop the base plan, functional annexes and hazard specific annexes.
California wildfires are expected and they are followed by landslides and floods. A changing culture in traditional responders has co-evolved with a culture of pet owner disaster preparedness in California. This is demonstrated by the documentation of the in California wildfires from 2003–2009. The 2003 wildfires in San Diego County involved a massive relocation of people, small companion animals and over 700 horses. It was a milestone event in allowing co-located human and animal shelters. The intent was for animals to be maintained in adjacent shelters, but the result was humans taking up residence with their animal companions. Pet owners sought to keep their family, including their pets, together. It appeared that pets were providing comfort to their owners. In the same region during 2007, pet owners mobilized rapidly. They were clearly more prepared than they were in 2003. During 2008, a record 1400 fires were burning in California on July 1st. The Santa Barbara Gap Fire mobilized an expert Santa Barbara Equine evacuation team. The human Red Cross evacuation center allowed small animal cohabitation. At the same time, the Butte Lightning Complex fires (37 fires) involved a unique cohort of canine evacuees for an extended duration and requiring unprecedented veterinary volunteers. In 2009, the Santa Barbara Jesusita fire threatened an urban area and evacuation of 35,000 people. It included a vulnerable human population with health disabilities that required ambulance evacuation assistance. Small companion animals were allowed to evacuate in the front cab of the ambulance. Ambulance drivers remarked that they dreaded forcing patients to leave behind their pets and it was a relief to bring the pets along. In summary, the response to repeated California wildfires from 2003 to 2009 has demonstrated an evolving culture of animal disaster preparedness for both traditional responders and companion animal owners.
Following the devastating March 2009 Victorian bushfire disaster in rural areas of Australia, authorities reviewed strategies designed to protect communities during periods of extreme fire risk. New policy and regulation were introduced and designed to ensure that small rural communities were protected and prepared to confront a wildfire emergency during days of extreme heat or bushfire risk weather. As a result on days of declared ‘catastrophic’ bushfire weather conditions government agencies in South Australia have implemented a policy for schools (including pre-schools) to be temporarily closed. On these days community members are advised to evacuate early to safe regional centres, and to limit travel on country roads. The WADEM Guidelines for Disaster Evaluation and Research demonstrate that Basic Societal Functions (BSFs), such as education, health, transport and others, are interconnected and interdependent. For example in small rural communities in South Australia people may have a number of important roles including being parents, volunteers of emergency services while also being employed as staff of local hospitals. This project reviewed the impact of school closures and other protective measures on the availability of the rural nursing workforce and on rural hospitals. Rural hospitals in Australia are staffed, on average, by 2–8 nurses, service very small communities and are separated by great distances. As a result, small changes in the absentee rate for nurses can have a significant impact on the operation of these hospitals. This paper will argue that policy changes in other sectors, such as education, can impact on societal activities such as childcare, volunteer emergency service work, and hospital staffing, in ways that may not be anticipated unless the impact on all Basic Societal Functions are considered by policymakers.
Disaster health management policies are being developed and implemented by various government and non-governmental organizations. However, there has been a lack of studies to comprehensively identify the key elements in the successful disaster health management policies.
Methods
A survey of experts was used to identify key elements of successful disaster health management policy arrangements. This research conducted 10 face-to-face interviews, together with 22 e-mail surveys to identify the key elements. The experts were selected based on the person's background and expertise in disaster health management and policy analysis.
Results
Key elements of disaster health management policies were identified and introduced in four parts, including the characteristics of conceptual policy framework of disaster health management (risk assessment and recognition, strategic view, resilience community, inclusive and accountable, good structure with clear authority, fault tolerant, good communication, rigidity and flexibility, education and training, mutual understanding, effective funding), elements of policy development (adequate leadership, extensive consultation, clear goals and terms, easy to access and implement, locally owned and accepted, standard and flexibility, linkage with other policies, keep updated, involve all the stakeholders, regular drills as part of the policy), elements of policy implementation (well defined structure and agencies, professional disaster management body, delegate the power and coordination, maintain interests and involvement, communication, recognition of disaster risks, policy familiarity, full participation of health elements, financial support, specific measurement), and elements of policy effectiveness evaluation (advisory committee, evaluate true disasters, evaluate policies in exercises and drills, test people's knowledge, evidence of stakeholders contributing, practice and procedural change, evaluate operating procedural, scientific evidence).
Conclusions
Key elements must be considered in developing, implementing, and evaluating of disaster health management policies to ensure the success of these policies.
The Tel Hai college Department of Social Work established this program as part of its community commitment to ensure that persons with skills in emergency mental health / trauma intervention will be available to the community as first responders when needed. The main goal of the STSP: Training Social work students As First Responders with Very High Professional Standards of Emergency as well as Long Term Mental Health Interventions Qualifications. This program enables the students to integrate between theory and hands-on basic and advanced skills in stress & trauma interventions – from the help to a single traumatized person to mass disasters involving more complex interventions. In addition, program underlines and empowers the students self efficacy and resilience. The studies are carried out in 4 main channels: A. Academic studies and advanced professional workshops. B. Outdoor drills with other help and rescue units: MDA (EMS), IDF, Police, Israel fire and rescue services, local and national rescue units) C. Volunteering in community trauma / first responder units D. Emergency mental health interventions during real time events (Last one: Emergency interventions among the evacuated families during the mount Carmel bushfire) Student's Skills Acquired During the STSP • Theoretical & practical knowledge of the stress & trauma development process. • Differentional diagnosis of the trauma stages (From ASR to C-PTSD). • Identifying all sources of resilience and coping strategies. • Basic & advanced crisis and disaster intervention methods. • Crisis & disaster management & command • Professional self confidence, Independency & Creativity, leadership and leading capabilities. The program, its benefits and latest drills and real time intervention will be discussed as well as demonstrated with videos.
Although emergencies involving mass casualties following the release of chemical or radiological agents are rare, the risks are well-recognized and many countries have prepared national response plans. The MASH (Mass Casualties and Health) study, partially funded by the European Commission, examined preparations for mass-casualty management and associated health risks within the Member States of the European Union (EU). The objective of the study was to improve the overall capacity to manage mass-casualty incidents that may equally outstretch the resources of a single country or involve several states simultaneously. Through confidential questionnaires and other means, MASH investigated the current response capabilities and planning for chemical and radiological incidents within the EU and also explored, through a number of seminars, developments in information and communications technologies, together with relevant developments in biotechnology which could improve a unified response. Finally, a foresight study has identified a number of areas for improvement and identifies six strategic aims for EU Member States to cope with chemical and radiological mass casualties. This presentation will cover the main findings of the MASH study and consider its wider message for chemical and radiological incidents worldwide.
The Republic of Palau, like other small, island, developing states, is particularly vulnerable to climate change due to a number of factors, including: (1) small size; (2) remoteness; (3) limited natural resources; and (3) vulnerability to disasters and extreme weather events. Other factors include social and economic factors such as: (1) economies sensitive to external shocks; (2) high population growth rates and densities; (3) poorly developed infrastructure; (4) limited financial and human resources; and (5) emigration. The (US) Centers for Disease Control and Prevention (CDC) partnered with the Republic of Palau Ministry of Health (MoH) and Southern Illinois University (SIU) to investigate public health consequences in Palau. The goal of the project is to reduce morbidity and mortality due to climate change in Palau by improving awareness using three tools: (1) a photojournalism book to document the local experience in Palau; (2) a marketing campaign to increase awareness in Palau about climate change as it relates to human health; and (3) a Website to raise regional and international awareness of the findings, and act as a forum for discussion and resource-sharing.
Methods
The CDC, SIU, and Palau MoH conducted interviews with community members including government officials, traditional leadership, fishermen, gardeners, physicians, scientists and local residents to explore their experiences concerning climate change in their community. Photojournalists took thousands of images documenting locally identified effects of climate change that were perceived as having direct or indirect health consequences for the people of Palau.
Results
Coral bleaching, beach erosion, irregular rainfall, sea level rise, and salt water inundation directly impact food security and tourism in Palau, while other less obvious, but important consequences, such as potential loss of traditional practices and cultural identity were also identified.
Conclusions
The people of Palau reported significant impact from climate change on agriculture, economics, health, and culture.
Trauma care is one of the key components of disaster medicine. However, it is difficult in Japan to gain extensive experience in trauma surgery, especially penetrating trauma. The Advanced Trauma Operative Management (ATOM) course was developed as a model for teaching operative trauma techniques to surgical residents, fellows, and attending surgeons as the number of these cases decreases in the US. In 2008, a new ATOM training site was established at Jichi Medical University in Japan, and as of December, 2010, five courses have been offered.
Methods
The ATOM course consists of lectures and a porcine operative experience. Comprehensive evaluation of ATOM was designed to assess participant learning in the cognitive, affective, and psychomotor domains. Data on the first 36 participants was retrospectively collected and analyzed.
Results
Participants included: 20 expert trauma surgeons, and 16 general surgeons. All groups showed improvement in knowledge (pre-test score: 61.9 ± 16.4 (mean ± standard deviation), post-test score: 70.6 ± 16.5, p-value < 0.001) with results in the expert and fellow groups reaching statistical significance. Self-confidence also improved (pre-evaluation score: 65.4 ± 17.6, post-evaluation score: 82.0 ± 9.4, p-value < 0.001), with all groups reaching statistical significance.
Discussion
This course creates real operative situations in a standardized fashion that improves knowledge and operative confidence for trauma operations, which may be of great benefit in disaster medicine training.
Tourniquets have reappeared in the management of massive hemorrhage and as a tool to ameliorate the effects of reperfusion injury from limb entrapment or suspension trauma, while the patient is rescued to a safer environment. Strategies to minimize subsequent reperfusion injury were investigated in this prospective, randomized study.
Methods
In the safety of an operating theater, sixteen fit and healthy patients scheduled for repair of bimalleolar ankle fractures were randomized into two groups. In the standard release group (R, n1 = 6), the tourniquet was fully deflated at the end of surgery. In the staggered release group (SR, n2 = 10), the tourniquet was fully deflated for 30 seconds and subsequently re-inflated to 300mmHg. The procedure was repeated twice at three-minute intervals prior to full removal. Hemodynamic and blood biochemistry measurements were obtained from an indwelling arterial catheter immediately prior to initial tourniquet deflation and thereafter at 1, 4, 7 and 15 minutes.
Results
Serum Ca2 + concentrations were less in group R at 4 (1.027 ± 0.5 vs. 1.084 ± 0.07mmol/l, p = 0.046) and 7 minutes (1.045 ± 0.04 vs. 1.110 + /- 0.06mmol/l, p = 0.013). Serum lactate concentration was greater in group R compared to group SR at 1 (1.75 ± 0.19 vs. 1.33 ± 0.31mmol/l, p = 0.005) and 4 minutes (1.98 ± 0.23 vs. 1.48 ± 0.39mmol/l, p = 0.007), respectively. End-tidal CO2 was less in group SR compared to group R at 1 (4.82 ± 0.45 vs. 5.68 ± 0.26kPa, p = 0.0004) and 4 minutes (5.01 ± 0.59 vs. 5.68 ± 0.35kPa, p = 0.01), respectively. At 15 minutes, less hypotension and bradycardia was noted in group SR.
Conclusions
A staggered tourniquet release was associated with greater hemodynamic stability and reduced the rate of acute systemic metabolic changes associated with limb reperfusion. Re-application of a tourniquet seemed to halt further reperfusion, providing a window period for patient evaluation and management.
To improve quality of life among subjects with crush injuries of extremities as an outcome of traumata of various aetiology by salvage procedures. To prevent or minimize psycho-social derangement or implications by minimizing partial or total loss of traumatized body parts and restore useful function.
Material
20 year study/observation in trauma of limbs, hands, feet, fingers, toes with partial to near total vascular compromise sustained in road traffic, industrial, domestic, suicidal, homicidal, war wounds, fire work blasts, etc. accidents.
Method
Pre-operative/follow-up counselling of every patient, attendants and employer are of utmost importance. Primary debridement, stabilization, skin cover and serial paraffin-gauge dressings are followed with straps/splints, passive/active range of movement exercises and delayed suture removal. Antibiotic cover with sequential cultures are mandatory.
Facts / Figures
Sepsis is a challenge. Males, youth, hands, Grade II wounds and RTAs dominate incidence. Contamination, delayed presentation, poor compliance and follow-up, poor nutritional status, anaemia, etc., dread salvage. Initial poor tissue perfusion is no indication for early decision to amputate/terminalize.
Results
Compromised vascular crushes in which primary closure was achieved, salvage of limb and appendages was surprisingly possible. Cosmesis in working class is never the priority, but restoration of function and more so the chance of livelihood are. Dexterity and confidence come with practice. Richer the patient, difficult to convince. Psycho-social depression is more with early amputations than in revisions and much less in salvaged groups, commoner in men and unmarried illiterate women. Women adapt better to salvaged parts.
Conclusion
Even a nail lost with its bed is lost for ever, leaving a painful defunct stump. No riches can truly compensate. If soft tissue cover on bony elements and neuro-vascular bundles is achievable, an entire limb may survive and regain near normal function. When crush wounds remain aseptic a decision to amputate can wait.
Psychosocial Tsunami Financial Crisis Tragedies produced by nature have patterns similar to psychosocial emergencies. The disruptive effects impact on Public Health. Unemployment covers society and doesn't allow personal aptitudes to emerge and sinks people in hopelessness. There is a perception of constant risk. People are in alert with all the effects of sharp and chronic stress and in some occasions Post Traumatic Stress.
Objective
To get an efficient answer to reality from this impoverished group with severe effects facing working uncertainty and unsatisfied basic needs. To avoid the social tragedy to be a big wave that sinks a big part of the population very quickly. To train people on the importance of work to get a better quality life for each participant, the family and community.
Methodology and Diagnosis
6200 people were trained in twenty months and motivated to work in a population of 95000 citizens approximately. They got a salary and social security financed by the government and articulated with the NGO. They were organized according to working experience and abilities and a supervisor was elected every ten people. Each participant had been polled to reach these conclusions. Industrial security, health care, and group work abilities were some of the syllabus topics. Some of the tasks performed were: painting, gardening, public places embellishment and fixing, administrative duties, river cleaning, etc.
Conclusion
90% of labour inclusion among unemployed people. Acknowledge from the participants of their working abilities. To generate hope in uncertainty diminishing violence. Generate space to diminish stress with impact in cardiology matters, addictions and pathologies. The disruptive effects of financial crisis are diminished considerably in these groups.
The possibility of natural disasters and public health emergencies coupled with the possibility of terrorism support the need to incorporate emergency preparedness into the curricula for every health professional school. Methods: A survey methodology was employed to assess both attitudes towards and knowledge of emergency preparedness amongst health professions students which included the schools of medicine, nursing, dentistry and public health. The survey was piloted to graduating students and then administered prior to institution of a emergency preparedness curriculum and then repeated as an annual survey.
Results
The survey found that 51.8% had been present at a disaster as non-responder while only 12.1% had ever been present as a responder. With regard to baseline class room exposure over 50% reported no exposure to such key concepts as incident command, triage, all-hazards planning, surge and aspects of terrorism. In addition at baseline most students felt they had no competency in emergency preparedness. As an example only 10% of students felt competent with personal protective equipment. While exposure both as a responder and student was low, 82.5% of students felt that emergency preparedness should be a mandatory topic in their education. Lastly, with a minimal curriculum change students showed statistically significant increases on knowledge testing.
Conclusions
While exposure was low for emergency preparedness topics and most did not recognize how information they had been taught might be applicable to emergency preparedness, there was a strong desire for additional training. In addition simple curricular adjustments can lead to significant improvements in knowledge.
In many developing countries nurses are the front-line of care, yet do not receive appropriate theoretical or clinical skills related to disaster and emergency medicine. The ICN/WHO have outlined disaster nursing competencies for improving disaster nursing globally. These can serve as a basis for strengthening nursing through increased participation in training programs. In Mumbai, India during December 2010, MEMEX II occurred: a 7 day training in disaster preparedness and humanitarian response. This was the first time nurses were included in a separate disaster nursing track to improve skills and knowledge.
Methods
Through Cornell and Columbia Universities; faculty, Indian nurses clinical competencies and disaster theory were strengthened through training in clinical trauma management, CPR, disaster preparedness and drills, public health evaluation, and the disaster cycle. 700 participants from medical, education, government and private/public entities collaborated in the training program, culminating in a large scale disaster drill and needs assessment workshop for high-level stakeholders.
Results
Nurses improved emergency clinical skills and gained theoretical disaster knowledge for the first time. Nurses located at the disaster event site gained important insight into the role of Emergency Medical Services, police, fire, and civilian defense during disaster response. Triage skills were improved and an evaluation component enabled vital information to be collected for hospital preparedness. A video was made for future training and for evaluation purposes. Nurses planned to establish coordination networks amongst the 9 hospitals present to regularly review disaster preparedness plans.
Conclusions
Strengthening nursing competencies in disaster planning and emergency response is vital to advancing nursing in developing countries and building capacity through global networking. Through a multi-disciplinary approach, professional networks can be formed, disaster plans reviewed and clinical skills improved. Nursing input is vital to hospital and community preparedness and nurses must be included in training programs and needs assessments.
Equine emergency shelters have an increased risk of infectious disease occurrences due to increased animal stress levels, excessive co-mingling, inconsistent worker base, and horses arriving from many and varied health management and stabling situations. Biosecurity policies should be in place ahead of time to prevent disease spread and outbreak situations and policies should be effectively conveyed to all shelter personnel. A veterinarian should be involved in the overall health management of an equine emergency shelter including working with public health officials regarding the overall animal and human safety issues associated with effectively managing an equine shelter. The veterinarian should work closely with the shelter manager and both need to be able to apply Incident Command System and National Incident Management Systems applications to maximize disease prevention. Mitigation tactics should include appropriate regular equine health maintenance including current vaccinations against tetanus, Equine Influenza I & II, Equine Herpes virus I & IV, and the encephalitides including Eastern, Western, and West Nile Viruses as part of horse owner emergency preparedness planning. Equine Infectious Anemia (EIA) is a federally regulated equine disease and during disaster situations it is unrealistic to assume that all horses will have a record of a current negative test. EIA testing should be considered a part of the plan for shelter animals depending on risk assessments. Appropriate personal hygiene, particularly hand hygiene, can assist in the prevention of disease transmission. Separate isolation areas are necessary for horses showing clinical signs of infectious disease including fever, nasal discharge, or diarrhea. Equine emergency shelter husbandry plans should include a plan for safe handling of feedstuffs, and water. An effective and implementable biosecurity plan for equine emergency sheltering is a key critical requirement for successful large animal emergency and disaster response outcome.
A disaster may result from a serious or sudden catastrophic event that has the potential for massive loss of infrastructure and significant mortality and morbidity. Disasters may be caused by natural or man-made events. With either type, the forces of the event overwhelm the first responders and health organizations in the stricken community and outside assistance is required. Developing countries have the highest burden with limited available resources. Today's complex disasters have increased the need for mobile medical/surgical response teams to provide disaster care. The United States (US) Government created the International Medical Surgical Response Teams (IMSuRT), which, on short notice, deploy a multidisciplinary team of doctors, nurses, and other health professionals to disasters around the world. IMSuRT has a rapidly deployable, fully equipped field hospital. Historically, Massachusetts General Hospital (MGH) in Boston, Massachusetts, US, has played a significant role in responding to humanitarian efforts both within the US and internationally. The MGH nurses play key roles in several response teams, including IMSuRT. Disaster nursing has many unique challenges. Nurses practice daily under controlled situations and become expert in one specialty; however, in the disaster setting this is not possible. Disaster nursing requires a fundamental change in the care of patients. During disasters, nurses work in areas that are not their primary specialty. Disaster nurses must be prepared in the essentials of disaster response- this requires planning, preparation, and training with multiple simulation drills focusing on patient scenarios, equipment utilization, teamwork, triage, decontamination, and scene safety. We must be creative, adaptable, and flexible to the needs of the disaster. Most importantly, cultural sensitivity, and communication are important factors in the delivery of disaster care.
Certain disposable items such as Percutaneous Tracheostomy (PT) sets and intracranial pressure (ICP) monitoring sets are expensive and a major drain on resources of public funded hospitals.
Aims
To assess the use and cost-effectiveness of reusing expensive disposables (PT& ICP sensor) in a neurosurgery intensive care unit (ICU). Another objective was to assess the importance of bedside Tracheostomy and ICP insertion in an ICU rather than in OT.
Methods
An observational, retro-prospective study was done from January 2008 to November 2010 in the neurosurgical department of JPN Apex Trauma Center. Retrospective data on surgeries performed in Neurosurgery OT were taken for the year 2008 and following introduction of PT and bedside ICP monitoring sets in ICU, prospective data were collected from November 2009 in the neurosurgery ICU. Each set was tagged according to number of times used. A procedure book was maintained, in which each case along with the set used was mentioned.
Results
Of the 1209 surgeries performed in the neurosurgical OT in 2008–2009, 257 were minor procedures (238 open tracheostomy and 19 ICP transducer placements). In 2009–10, 236 percutaneous tracheostomies were performed in the ICU. Of these, 79 (33.4%) were new and 157 (66.5%) were re-used sets. The cost of a new PT set is Rs 15,000. With re-use, the average price per set came down to Rs 5,033. In the same period, 231 disposable ICP transducers were placed with an average of 19 cases per month (range 5–28). Of these, 142 (61%) were new ICP sets and 97 (42%) were ethylene oxide (ETO) sterilized. The cost of new ICP set is Rs 35,000. With re-use, the average price per set came down to Rs 21,515.
Conclusion
Nearly 40% of minor procedures are now excluded from the Neurosurgery OT statistics, as they are being performed in the ICU. This study shows that expensive disposable items can be re-used effectively, bringing immense cost savings to hospitals.
During the past four years large scale biological exercises took place in several districts of the state of Israel. The drills included hospitals, Health Maintenance Organizations (HMOs), Emergency Medical Services (EMS), public health district offices and interface agencies such as Israel Defense Forces (IDF) Home Front Command (HFC).
Discussion and Observations
On January 2010 a comprehensive biological exercise was conducted in Tel Aviv. Tel Aviv Sourasky Medical Center (TASMC) together with the agencies mentioned above practiced the hospital competing with Exceptional Biological Event. New elements, which had never been inspected before, were evaluated in this drill:
• Activating of a triage point at the hospital gate.
• Opening a special registration point.
• Staff protection from biological agents.
• Activating a separate Emergency Department (ED) for bio- threat.
• Detection and Containment ward.
• Protected elevators and passageways
• Interface agencies in and out the hospital.
Designated physicians, nurses and paramedical team, that practiced other events in the past, needed to be trained and practiced in order to be ready for a biological event. Wards that usually did not participate in such drills, needed to take part in this particular drill, while the routine work continued. This paper presents the hospital preparation for the drill, the methodology of training and preparedness, as well as the outcome of the drill.
Operation Smile International (OSI) is a Non-Government Organization (NGO) with experience providing surgical care throughout the world. OSI has vast logistical capacity, skilled and credential providers, and international relationships. Disaster response had been considered by OSI in the past, but never initiated. However, the magnitude of the Haiti disaster, coupled with request from Haitian OS Partners led to the initial disaster response of the OSI organization.
Discussion and Observations
This presentation will: (1) Describe the considerations and rationale that led OSI to this intervention. (2) Discuss the process of developing a disaster response within a relatively short period of time. (3) The response itself, and (4) Present how the lessons learned will be adapted to future OSI capacity and planning.